مجله دانشگاه علوم پزشکی بابل
سال یازدهم شماره 5 (پیاپی 52، آذر و دی 1388)

Application of stem cells in medical research and treatment has made a new horizon to progress in many disorders. So finding methods for better isolation and culture and maintenance of stem cells (SC) has a specific importance. Aim of this research was to evaluate the protective effects of 3 different layers of mesenchymal stem cells (MSC), mouse embryonic fibroblast (MEF) and 3T3 on Sc for increasing the amounts of cells for transplantation and differentiation. Blastocysts were obtained from 10 Balb/c pregnant mice. Collected embryos were put on 3 different feeder layers of mouse embryonic fibroblast (MEFs), Mesenchymal stem cells (MSC) and 3T3 cell line. Two or 3 days later, the zona pellucida was removed and after 5 days the inner cell mass (ICM) growth, was removed mechanically and changed to small multi-cellular clumps through trypsination. Then formed colonies were cultured on feeder layers. Finally the colonies were identified through staining with alkaline phosphates for their numbers and morphological characteristics. From 29 embryos put on MEF layer all t of them (100%) was attached. From 32 embryos put on the MSC layer (64.5%) was attached. While the amount of attaching of 20 blastocysts to the 3T3 feeder layer was low and none of them reach to the growth stage of the inner cell mass. The amount of colonies formation during three passages on MEF feeder layer was more than MSC feeder layer. Data analysis demonstrated a significant difference (p<0.05) in percentage and time of hatching and time for living of blastocysts Considering these three feeder layers, MEF was better than MSC and both of them had priority to 3T3.

One of the important aims in anesthetic management during ocular surgery is to provide adequate control of intraocular pressure (IOP) and increasing of this pressure would cause some dramatic complications even though visual loss. The aim of this research was to evaluate the effects of adding remifentanil to isoflurane anesthesia on intraocular pressure (IOP) and hemodynamic responses after intubation and during cataract surgery. This study was conducted as randomized clinical trial. Forty patients (20 in each group) enrolled and assigned in two group, isoflurane + remifentanil (R), and isoflurane + placebo (P). Anesthesia was induced in both groups with Na-thiopental 5 mg/kg and atracorium 0.5 mg/kg body weight. In group (R), the patients received1 µg/kg as bolus dose of remifentanil and then continuous infusion 0.1 µg/kg/min was started. In placebo group, saline was infused. IOP and mean arterial pressure (MAP) was measured at 8 different times (zero time, after premedication, after induction of anesthesia, immediately 3 and 6 min after intubation, at the end of surgery and 5 min after remifentanil stopping) by a blind surgeon to research. Primary IOP in group R was 12.7±3.1 mmhg, and in group P was 13.7±3.4 mmHg. After injection of premedication and induction drugs IOP was decreased obviously in two groups. In both groups mean IOP increased after intubation significantly and reach to 12.1±2.8 mmhg and 14.2±3.2 respectively in group R and P that this difference was not significant. Comparison of MAP between two groups only in third measure (after induction of anesthesia) was meaningful (74.6±14.9 in group R and 88.2±14.1 mmhg in group P) (p=0.005). This research was shown that adding of remifentanil to isoflurane in cataract anesthesia could prevent from increasing of IOP due to tracheal intubation.

Fifteen to forty percent of neonates developed to prolonged jaundice. Several therapeutic modalities have been used for the treatment of prolonged jaundice. This study was carried out to evaluate the effect of clofibrate on prolong jaundice in full term neonates. This double blind clinical trial study was done on 56 neonates that divided randomly in two groups. Treatment group received clofibrate 100mg/kg by oral and control group received sterile water. Inclusion criteria were term neonates with prolonged jaundice (bilirubin concentration higher than 10 mg/dl) in neonates older than 14 days old). All babies were fed exclusively by their own mother's milk. Exclusion criteria were using of phenobarbital or traditional medicine and neonates with clinical and paraclinical sign of liver disease or direct hyperbilirobinemia above 1.5 mg. Bilirubin concentrations were measured before and 72 hours after treatment and compared in both groups. Distribution of sex, blood group and Rh in mother and neonate and mean of age, birth weight, hematocrit and hemoglobin showed no significant difference before intervention between two groups. The mean level (mg/dl) of indirect bilirubin (11.7±1.4 in control and 12.4±1.6 in case) and direct bilirubin (0.4±0.1 in control and 0.5±0.1 in case) wasnt significant difference between two groups before treatment, but the mean level of indirect bilirubin after treatment in case (8.4±1.8) was significantly lower than control (10.4±2) (p=0.000). The mean level of direct bilirubin after treatment showed no significant difference between case (0.4±0.1) and control (0.5±0.1). Clofibrate is an effective agent in reduction of serum bilirubin level in term healthy neonates with prolonged jaundice.

Analgesia and reduction of hemodynamic changes during laryngoscopy and intubation are important aims of general anesthesia, this aim usually obtained by administration of opioids. Since opioid drugs may cause respiratory depression in the neonates, they are usually omitted at induction of anesthesia for cesarean. But in conditions such as maternal heart disease, increase in heart rate and blood pressure may be detrimental, and use of an opioid can be justified. Short acting opioids for example remifentanil can have less side effects in the neonates. The aim of this study was to evaluate the effects of remifentanil on maternal hemodynamic changes and neonatal Apgar scores during cesarean section. In this double blinded randomized clinical trial, 100 patients aged 18-30 years who underwent elective cesarean section, divided randomly into two equal groups (N=50). Remifentanil was infused at a dose of 0.2µg/kg/min in study group and normal saline was infused in control group. Maternal blood pressure and heart rate were measured before induction and then every 1 minute. Apgar scores were measured 1 and 5 min after birth in both groups and then compared. Mean systolic arterial pressure, 1 and 5 minutes after the intubation was 118.28±15.16, 125.30±15.24 and 118.04±21.13 mmHg in case group and it was 124.78±17.57, 147.20±28.20 and 133.80±23.76 mmHg in control group that the difference was statistically significant (p<0.05). The mean of first minute Apgar Score was 8.84±0.42 in remifentanil group and 8.56±0.57 in control group. The fifth minute Apgar score in both groups was 10. According to the results of this study, infusion of remifentanil effectively attenuated the hemodynamic changes after induction and tracheal intubation. Since, remifentanil crosses the placenta and may cause mild respiratory depression in neonates so it should be used for clear maternal indications when adequate facilities for resuscitation of neonates are available.

Since neonates have higher pain sensitivity, pain management has become a crucial part of neonatal care and cure. The objective of this study was to compare the effect of breast-sucking with being in the mother's hug on pain relieving during immunization injection. This controlled trial study was performed on 76 healthy term infants with 2-4 months years old. They were divided into two groups. By randomized collection one group were breast-fed, 2 minutes before, during, and 15 seconds after the injection, and second were in their mother's hug 2 minutes before, during, and 15 seconds after the injection. Modified Behavioral Pain Scale (MBPS) assessed objective changes in appearance of neonates (facial expression, cry and movements) during 5 second before immunization to 15 second after it. The scores for each behavior were calculated and compared in two groups. There were significant differences in behavioral pain scores of breast-fed group (4.6±1.8) and mother's hug (6.7±1.2) include facial expression (p=0.032), cry (p=0.0001) and movements (p=0.0001) and there is no statistically significant difference found between the 2 groups for age, sex and the time of feeding prior to vaccination. Breast-feeding may have an analgesic effect during immunization injections in healthy neonates.

Intensive physical exercise influences physical and psychological stress that causes the hormonal and immune variations. The aim of this study was to assess the effect of resistance and endurance trainings on salivary immunoglobulin A (IgA), cortisol, Dehydroepiandrosterone (DHEA) concentration in untrained females. This research was quasi-experimental. Twenty nine untrained female students (aged; 24 2.2 yr, height; 161  7.6 cm, weight; 58.6  7.12 kg) were selected voluntarily and objectively and were divided into three groups randomly; control (C; n=9), endurance (E; n=10), resistance (S; n=10). E training consisted of running 65% MHR for 16 minutes during the first week, reaching 80% MHR for 30 minutes during the 8th week. S training consisted of having four leg-press, bench-press, pull down curls, and legs curls. During the first week, the training was done at 50% 1RM (one repetition maximum) in two sets with 10 repetitions. The intensity of training was increased to %80 1RM in 3 sets and 6 repetitions, during the 8th week. Before and after of 4 and 8 weeks of trainings 5ml unstimulated saliva were collected at 8 o’clock in the morning. IgA, DHEA and cortisol variations were measured by salivary kits and ELISA. The results showed IgA concentration of S group had significant increase after 4 weeks of training which in the comparison between groups this difference was significant (f=17.97, p=0.000). DHEA concentration showed significant difference between S group compared with another groups which increased in S group (f=4.96, p=0.006). In comparison of stage 3 to stage 1 DHEA/cortisol ratio showed significant difference between S group compared with another groups (f=3.52, p=0.025). There was no alteration in cortisol concentration of groups and significant correlation was not found between IgA and cortisol. Duration and intensity of trainings had no effect on immune system and risk of infection. Increase of body anabolic states probably results of resistance trainings.

Despite an abundance of literature, describing the basic mechanisms of action of L-carnitine, there remains some uncertainty regarding the effects of supplementation on fatty metabolism in healthy subjects. The purpose of this investigation was to determine the effects of acute oral L-carnitine supplementation on fat metabolism responses and endurance performance. In this semi experimental study, thirty-four healthy male subjects consist of two experimental (n=17) and control (n=17) group performed a submaximal exercise protocol on cycle ergometer (PWC170) in two separate stages. In first stage, exercise protocol performed without L-carnitine or placebo (Lactose) supplementation. In second stage, exercise protocol performed with acute L-carnitine or placebo supplementation (3g, 90 minute before exercise). Blood samples were taken immediately after exercise protocol for analyze and calculation plasma concentrations of free fatty acid, triglyceride and the other fat metabolism indexes (LDL, HDL, TC, Lipase (and then two groups were compared. The finding showed that there were no significantly differences between pre and posttest in plasma concentrations of free fatty acid (0.69±0.24 versus 0.72±0.14 mg/dL and triglyceride (158±46 versus 155±47 mg/dL. The rest and exercise heart rate and VO2max was 36±11 versus 35±9 mL/min. The mitochondrial transport of free fatty acid does not increase by L-carnitine supplementation. Collectively, L-carnitine supplementation would be unlikely to be associated with change in fat-carbohydrate metabolism in healthy people and it's not influence in improving of endurance performance.

Infertility involves pregnancy failure without using preventive measures for a year post intercourse. Transvaginal color Doppler ultrasonography (TCDU) is a method used for infertility diagnosis. Unexplained infertility diagnosed when all standard evaluations of infertility become normal. The uterine arteries hemodynamic indexes (UAHI) as a useful mean for pregnancy evaluation will be changed pre and post gestation. The aim of the present study was to determine UAHI changes in unexplained infertility via TCDU.

This prospective cohort study was done 50 women with unexplained infertility in Al Zahra hospital, Tabriz in September of 2005. The transvaginal color Doppler ultrasonography performed on patients in the 2nd day of menstruation and post intrauterine insemination. Human chorionic gonadotrophin (HCG) (5000-10000 IU) was intramuscularly injected post dominant follicle observation (17-18 mm diameter). Intra uterine insemination was then performed 24-48 h later. Then, hemodynamic indexes including uterine arteries, endometrial thickness and echogenicity were measured by sonography and compared in pregnant and non pregnant groups.

No significant difference found between mean right and left uterine arteries hemodynamic indexes on 2nd day of menstruation and HCG injection day in non-pregnant and pregnant groups. Mean pulsatility index was raised with the increase of endometrial thickness in non-pregnant and decreased with the increase of endometrial thickness in pregnant women.

The present study showed that uterine arteries hemodynamic index changes may not be a reliable method to evaluate pregnancy in women with unexplained infertility.

Signs and symptoms of temporomandibular joint disorders (TMDs) are common among individuals. Occlusal changes can be responsible for otalgia, hearing loss, tongue and throat irritation, and tinnitus. The aim of this study was to evaluate the prevalence of tinnitus in students with temporomandibular disorder in medical sciences and technology universities in Babol, Iran. This cross sectional study was performed on 592 students of both universities of medical sciences and technology of Babol, Iran during 2007-2008. All participants were asked to fulfill a RDC/TMD revised questionnaire and were subjected to a standardized clinical examination readapted from the RDC for TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Tinnitus cases were examined by an ENT specialist and underwent audiometry and tympanometry. In this study, TMD prevalence was 28.9% (171 patients) that was seen more in males (p=0.04). Tinnitus was seen in 21 cases (12.3%) with TMD and in 38 cases (9.02%) without TMD that there was no significant difference. Tinnitus was seen in 42 cases (13%) of medical students and 17 (6.3%) of technology university students that this difference was significant (p=0.04). Hearing loss was seen in 14 cases (8.18%) with TMD and 26 (6.17%) without TMD that there was no significant difference. The results of this study showed that there was not a significant relationship between temporomandibular joint disorders and tinnius.

In diabetes type II, the prevalence of the hypercholesterol is about 28-34% and hypertriglyseridemia is 5-14%. With regard to the reducing effect of the phytosterols on cholesterol and HDL-C of the serum, this study has been conducted to examine relation of phytosterols intake on serum lipids in type II diabetic patients. This cross section study was performed on 200 patients with the Diabetes Type II who referred to the clinic of Diabetes type II in Sabzevar town. After taking written consent from the subjects, questionnaires were completed by an experienced interviewer privately and face to face. The weight as well as their height was measured according to the standardized criteria. Using 24 hour reminder, the essential data on receiving food and feeding frequency was obtained through three consecutive days. Then, the phytosterol content of the food was calculated. Plasma glucose, total cholesterol and triglisride and HDL-C of the serum was determined and formulated through enzymatic calorimetry and LDL-C and then compared. In this study, mean of BMI of patients were 26.3±1.7 Kg. per sq.m. The average of total cholesterol in group 1 was 263.08±108.52 and in group 2 was 223.02±77.65 mg. per deciliter (p=0.016). The average of LDL-C in group 1 was 168.60±104.78 and in group 2 was 139.21±71.10 mg. per deciliter (p=0.014). LDL-C and HDL-C of the patients’ serum was 151.14±86.67 and 48.58±6.28 mg. per deciliter, respectively. The average dose of the phytosterols in these patients was 376.09±134.43 mg. per day. Phytosterol intake in doses of more than 200 mg. per day with total cholesterol and LDL-C of the diabetic patients type II has a significant inverse correlation. The concluding results in this study demonstrate that phytosterol intake in doses of more than 200 mg. per day due to a decrease in total cholesterols and LDL-C of the diabetic patients type II.

Rabies is fatal viral encephalitis in warm blood animals. Mazandaran province had been the 2nd most rabies contaminated province in Iran in 1993, therefore selected for the following study. The aim of this study was to assess the rate of rabies prevalence, the causes affecting the increase or decrease of rabies, human rabies cases and their causes, frequency of animal bites and the species of the responsible biting animals, and evaluation of the trend of rabies due to control measures, in Mazandaran province. This retrospective study was performed based on the data for human and animal cases of rabies according to the data of WHO collaborating center for reference and research on rabies, Pasteur institute of Iran and the records of rabies post-exposure treatment centers in Mazandaran during 11 years. The diagnostic method is direct immunofluorescent and for final confirmation the MIT, RTCIT methods used. A questionnaire consisting; the number of bitten individuals, the sort of treatment, the species of the responsible biting animals and the morbidity due to rabies, were filled and assessed. The data obtained, showed that from a total of 657 suspected rabies cases in this province, 406 were positive and 251 negative, the most positive cases, respectively were, bovines cow and dog. Meanwhile in the recent decade a total of 52300 persons bitten by animals and were received post-exposure treatment, and four persons died due to rabies. This survey showed that, rabies is prevalent in geographical condition of Mazandaran province, but implementation of rabies control, such as eliminating of reservoirs and carriers, immunization of owned animals, educating and notification people, could decrease the risk of the disease.

Stent fracture (SF), in peripheral vessels and although in coronary arteries has been reported. Very late and after one year stent thrombosis in drug eluting stent (DES) is a rare phenomenon and its most frequent cause is discontinuation of clopidogrel. Considering SF and stent thrombosis occurring together could result in lethal cardiac events; its recognition has considerable importance. This report presents a case of stent fracture and very late stent thrombosis.CASE: In this report a 59-year-old male patient was presented for whom coronary angiography and angioplasty were performed. We put a stent for him. While he was in good condition until 15 months after angioplasty, he was suddenly presented with chest pain and cardiac arrest and was admitted in the hospital. His life was saved with DC shock. Repeat coronary angiography was performed for him which showed SF accompanied by thrombosis as the cause of acute myocardial infarction.

Stent thrombosis may occur lately after DES and although it is rare, one of its causes is SF and the clinical presentation is usually dangerous and lethal.